The Clinician Investigator Program in Anesthesia at the University of Toronto

The Department of Anesthesia at the University of Toronto is the largest Anesthesia program in Canada and likely the most prolific for research and education. The opportunities for discovery and innovation within our Department abound. The Clinician Investigator Program (CIP) provides a unique opportunity to applicants who are interested in pursuing a career as a clinician scientist, combining medical practice and research.

For additional information, please see the website of the Clinician Investigator Program at the University of Toronto at CIPToronto and from the Special Program Training Requirements for the Clinician Investigator Program published by the Royal College of Physicians and Surgeons of Canada.

Background

The University of Toronto Clinician Investigator Program (CIP) is an accredited Postgraduate Training Program of the Royal College of Physicians and Surgeons of Canada. It was the first fully accredited program in Canada and it is now the largest, with approximately 100 trainees enrolled. The Department of Anesthesia CIP graduates have contributed immensely to the advancement of our specialty and they now have faculty appointment at the University of Toronto or other large research-oriented universities in Canada.

The goals of the Anesthesia Clinician Investigator Program are:

• to support research training for anesthesia residents enrolled in a graduate degree program;
• to provide a postdoctoral research experience for anesthesia residents who already hold a doctoral degree

Duration of the CIP Training

To achieve these goals and receive the Attestation of Completion of the Clinician Investigator Program, a minimum of 2 years of continuous, intensive research training must be undertaken. During the 2 years of research, the majority of time (at least 80%) must be devoted to research, but some time may be spent in clinical activities (i.e the equivalent of 1 day per week).

Up to one of the research years may also be credited to fulfil the Royal College accredited clinical program requirements with joint approval of the faculty CIP director and the program director. Therefore, the CIP will extend anesthesia residency training by only one year, to a total of minimum 6 years. Additional research training in all CIP pathways can be extended to allow completion of a PhD or other research experiences and will further extend training.

CIP Training Streams

The Anesthesia Clinician Investigator Program is offered in two training streams:

• The Graduate Stream, where applicants enroll in graduate (M.Sc. or Ph.D.) programs at the University of Toronto. CIP trainees can undertake research not only in laboratory and clinical biomedical research but also in other health care-related fields including education, health care economics, social, behavioural and information sciences, etc. Graduate Units at the University of Toronto that have participated in the program include Institute of Medical Science, Institute of Health Policy, Management and Evaluation, Public Health, Education, Laboratory Medicine and Pathobiology, Medical Biophysics, Institute of Biomaterials and Biomedical Engineering and Physiology. For successful completion of this program, CIP trainees in the Graduate Stream must fulfill all the requirements for clinical Anesthesia specialty training, and also all the course and thesis requirements of the graduate degree program they are enrolled in.
• The Postdoctoral Stream is intended for anesthesia residents who already have a doctoral degree (Ph.D.) and are interested in undertaking a structured research program in a specialized area. Although the research training may be individualized, it but must be similar in content and rigor to a graduate school degree program. For Postdoctoral Stream trainees, completion of the research component means successfully attaining the specified research goals and objectives to the satisfaction of the CIP Committee.

Funding for CIP Training

Successful candidates will have the salary and tuition covered for 2 years of research. There are various sources of funding and once enrolled in the program, residents will be mentored and guided to find the best funding strategy for training.

The CIP trainees are encouraged to apply for external salary awards and grants to support their research training and enrich their portfolio.

CIP Entry Pathways

There are 2 entry pathways into the CIP:

Direct application to the CIP stream through CaRMS. This pathway is preferred because it secures a position in the CIP, it allows better planning of the research training and ongoing mentorship from the beginning of the postgraduate training. Please note that applying to the CIP stream will not negatively impact your application to the regular residency stream of our program, should you also apply. Candidates who apply to the CIP stream will ALSO need to apply to the regular residency stream to be considered if unsuccessful at CIP.

Residents who enter through the regular stream in the Anesthesia Training Program at the University of Toronto can still apply to CIP provided that there are available positions unfilled (only 2 CIP residents/year of training are generally available in the Department of Anesthesia). Generally, the application deadlines for residents already in the anesthesia program are May 1 for July 1 enrollment and November 1 for January 1 enrollment. CIP applications and instruction can be found on the U of T CIP website.

All residents who are accepted in the CIP stream have a position secured in the regular training program.

Clinical Training:

Clinical training in the CIP is the same as the CMG program, except there are 4 years for clinical training.

The University of Toronto offers a comprehensive program in Anesthesia, which is fully accredited by the Royal College of Physicians and Surgeons of Canada. Over 350 staff anesthesiologists at multiple sites are involved in resident education. These sites include: The Hospital for Sick Children; Mount Sinai Hospital; St. Michael’s Hospital; Sunnybrook Health Sciences Centre, at both the Sunnybrook and Holland Centre campuses; Michael Garron Hospital; St. Joseph’s Health Science Centre; The University Health Network at both the Toronto General and Toronto Western Hospitals and Women’s College Hospital. Each of these hospitals has a particular clinical focus and specific training opportunities which allows the program as a whole to offer residents an exceptional experience in all areas of Anesthetic practice.

The experience that residents obtain with respect to volume and variety of clinical opportunities, both patients and procedures, is unparalleled. All subspecialties of anesthesia are offered in Toronto and this means that our residents have opportunities for training in ALL areas of anesthesia practice during their residency — all within their own program. For example, residents experience Obstetrical Anesthesia longitudinally throughout their training and, in addition, have a full protected block rotation in high-risk quaternary-care Ob-Anesthesia.

Other unique opportunities and strengths of our program include:

• Simulation: There are two high fidelity Anesthesia Simulation Centers in the Department, a Surgical Skills Center, and additional high fidelity simulators within most hospitals, all used for resident education. These are used for clinical training of anesthesia residents and multidisciplinary teams particularly in the areas of technical skills, critical event training and crisis resource management. Residents participate in simulator sessions throughout residency and, in addition, senior residents are involved in the supervision and teaching of medical students in the simulator at our Sunnybrook site. We have also expanded the use of simulation in other areas including a comprehensive advanced airway management course, vascular access and regional anesthesia. In addition, each hospital has simulation opportunities for residents during rotations resulting in a robust longitudinal simulation curriculum.
• Regional anesthesia: This has become a major focus at a number of sites in the Department of Anesthesia at the University of Toronto. All residents have the opportunity to train in regional anesthesia longitudinally and also complete block rotations specific to regional anesthesia education and experience. This includes e-learning, simulation training and academic sessions all devoted to the acquisition of regional anesthesia skills. Many opportunities also exist for research in this field — particularly in the area of ultrasound-guided blocks.
• POCUS: All residents participate in a longitudinal Point of Care Ultrasound (POCUS) training curriculum which includes full-day bootcamps and a block rotation specific to POCUS technical and clinical skills including cardiac, lung, FAST and gastric. There are also academic sessions throughout the year devoted to POCUS training. Residents have access to a spectrum of POCUS resources including trained faculty, US machines, TEE simulators and on-line materials on this site.
• Academic Curriculum: Our program boasts a very robust Academic Curriculum including morning teaching at all sites and protected academic half-days. Protected academic time includes teaching sessions as well as protected time for wellness, mentorship, individual and group study dedicated to developing the non-medical expert CanMEDS competencies. In addition, we have a full day Resident Education Day in November each year organized by the Departmental Chief Residents focusing on specific theme. This year, the focus of our Education Day was on Dismantling Dominant Ideologies in Medicine: Equity, Diversity, and Inclusion for Patient Advocacy. An important aspect of our academic curriculum is that it is heavily resident driven and there is strong resident input in refining the curriculum each year.

The final year of training is devoted to “Senior Revision Tutorial” which focuses on a detailed academic review and development of consultancy level judgement and critical thinking skills. Through this rigorous program, our residents are very well prepared for the Royal College Examinations and independent practice. Overall, our residents receive one half-day to one full day per week of protected academic time, including independent study time starting 6-months prior to the Royal College Written Examination.

Please visit our website for further information.

In addition to the robust and exciting clinical and academic opportunities, our residents are supported in many additional ways:

• Resident Leadership: As a resident-driven program, residents are encouraged to be involved in the development and governance of the program. Residents from each year are actively involved in and active members of the program including its committees (Residency Program Committee, Applicant Selection Committee, etc.). There are Chief Residents at each training site as well as Departmental Chief Resident(s) who serve as resident program leaders. They facilitate two-way flow of information and ideas, especially in the context of program reorganization and change. The opinions and feedback of our residents are essential and ensures trainee involvement in the design and ventilation any changes and that the residents are represented as true stakeholders in all process.
• Mentorship: Our residency program endeavours to continue the time-honoured mentorship of the medical profession in residency training by structuring a mentorship program that is aimed to enhance personal and professional development, and to provide guidance to all residents throughout their training. Our program has always had an open door policy for the residents to informally seek advice and support from faculty including Site Coordinators and the Program Director. In addition, residents entering into the program are assigned to a formal Mentorship Group and are paired with a Near-Peer for additional support.
• Academic Support: In addition to the academic support of the individual Site-Coordinators and the Program Director, every resident entering our program will be paired with an Academic Coach. The faculty member helps provide guidance and directed mentorship throughout resident training and directly supports residents in defining their learning objectives, finding their own solutions, and following their learning plans through to completion, while providing encouragement, motivation, and one-to-one dialogue.
• Resident Wellness: Our program has a Wellness Committee with a Faculty Lead and Resident Leads. The Resident Wellness Committee is responsible for providing vision and leadership in relation to resident wellness initiatives. The program also works closely with the University’s PGME Resident Wellness Office to support our residents individual needs.
• Social Committee: Part of resident life includes socialization and social events. Our resident Social Committee helps to organize events to maintain collegiality and help foster socialization amongst residents and faculty. An excellent example is our annual Sports Day and BBQ where residents and staff team up for a fun-filled day of games — all competing for the coveted “Laryngoscope Award” along with bragging rights and fund-raising for charity.